Information Collection

Request to be Selected as Payee

IC 13866 under ICR 202404-1240-001 · OMB 1240-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-910 Request to be Selected as Payee	Form
CM-910 Request To Be Selected As Payee CM-910 Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Form
CM-910 Request To Be Selected As Payee CM-910 Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Form

IC Title:

Request to be Selected as Payee

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 725.505-.513

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-910	Request To Be Selected As Payee	CM-910 Form.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/OWCP-2

FR Citation: 81 FR 25765

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	350	150	200
Annual IC Time Burden (Hours)	88	38	50
Annual IC Cost Burden (Dollars)	230	150	80

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.